Sunday, October 17, 2010

On Call: The Accountable Care Organization's Case of Mistaken Identity

03:45 am - * bleeeep bleeeep bleeeep *

Pulling his head from the pillow, he fumbled for the pager. Reaching across the nightstand, the contraption is knocked to the floor, sending the device's holster skittering across the cool, dark floor. After a few expletives were uttered beneath his breath, he locates the black sleep-deprivation device and presses its button:

"888-555-1234 CARDIAC ELECTROPHYSIOLOGY ON CALL"

His heart sinks. "At least it's not the ER" he thinks.

He carries the cordless phone to the adjacent room in a futile attempt to avoid waking his wife and calls the number. A robotic voice on the other end answers:

"You have reached Cardiac Electrophysiology. Our office is closed. If this is an emergency hang up and dial 911 or you may leave a message at the tone to be handled the next business day. If you'd like to speak to the doctor on call..."

He hits zero to shut the robot up. Horrific music with some type of horn that sounds like it has been flattened squeaks in the background. He waits.

And waits...

Finally:

Good morning. Cardiac Electrophysiology. How may I help you?

"This is Dr. Fisher returning your page."

"Yes, doctor, let me look up the page."

The horrific music returns, then:

"The call is from Justaya Smith. She has a fever to 101. He said her doctor is Dr. Jones."

"He said her doctor was Doctor Jones. Would you like their number or should I connect you?"

Realizing the futility of the situation, he states:

"Both, please."

"Thank you. Just a moment..."

Soon a man answers.

"Hello, this is Dr. Fisher returning your page..."

"Yes, thank you doctor. My daughter sees Doctor Jones and she's had a fever for the past five days. We've tried alternating Tylenol and ibuprofen, but her fever keeps coming back. This evening, she started to vomit..."

Expand on this. I just read an article on health.com that wrong site/wrong patient/wrong diagnosis is more common than expected. You take every opportunity to fault healthcare reform (see preceeding post on Facebook privacy). It's time for a little "balance" here. This info makes me want to reconsider giving you an easy route to tort reform. When these types of errors are fixed, then we can talk.

The Progessive Collective has determined that accountable care organizations will provide superior, higher quality and lower cost care to our nation's patients. Yet even now, as more and more doctors join these large health care organizations as employees, these organizations are contracting with entities unfamiliar with subtle nuances of health care (like differentiating a pediatrician from a cardiologist with the same last name). Granted, this could happen in any large hospital organization, but I am unfamiliar with a similar incident occuring when I worked in a smaller, more individualized practice setting.

The major reforms become active in 2014. Obviously, the errors found in the study have taken place well before 2014 and I would suppose before HCR was passed - perhaps even before 1/20/09. Would that absolve the "Progressive Collective"?

Your post told of a really annoying mistake. However, I thought it might lead to a post of a related but much bigger problem - the incidence of medical errors and why harmed patients may need access to legal remedies, not the inadequencies of a answering service.

I do not argue that things are not complicated. I just thought that in light of the study we might want to carefully consider tort reform. I'm sorry that docs are burdened with malpractice insurance. (I will resist the unhelpful remark that since it is not mandated, it is their constitutional right to refuse to carry it.) But if the wrong breast, leg, or prostate is taken, is it surprising that one might expect a legal remedy? If only to pay for the next procedure that has to take the second breast or leg. Of course the removal of the prostate will not have to be undergone again.

Things are complicated? I can't imagine that you would EVER offer that to a patient who had encountered some terrible mistake.

The major reforms become active in 2014. Obviously, the errors found in the study have taken place well before 2014 and I would suppose before HCR was passed - perhaps even before 1/20/09.

First, for many specialists, major reforms to doctors practices began the first of this year: witness the 40% cut to Medicare payments for outpatient cardiology imaging services and the loss of impatient "consultation" payments replaced by lower "evaluation and management" payments. The corporate consolidation of medicine, as evidenced by the loss of over half of private cardiology practices since then, is well underway. Large behemoth "accountable care organizations" will be the intentioned result.

Secondly, this post did not pertain to a "study," rather my personal on-call experience. I call 'em as I experience 'em, with names and places changed to protect the parties involved.

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.